Management of paroxysms of hypertension in patients with phaeochromocytomas

Abstract

Two patients with phaeochromocytomas developed crises in which severe hypertension alternated with profound hypotension.One patient died during a n emergency operation. T h e other was controlled with a long-acting alphacholinergic blocking agent and had his tumour removed uneventfully.PATIENTS with phaeochromocytomas may develop paroxysmal attacks of hypertension (Labbe, Tinel, and Doumer, 1922). Although a n almost rhythmical 2.5 0.25 PHENTOLAMl M Lv.(mg)$ $ NORADRENALINE DRIP mwere available. T h e second patient responded satisfactorily to phenoxybenzamine, and subsequent removal of the tumour was straightforward. CASE REPORTSCase I.-A 57-year-old farmer was admitted to the Royal Victoria Hospital, Belfast, on, 6 Feb., 1962, for investigation of headaches, excessive sweating, and irritability, which he had had for 3 months. He was rather obese, but the only other abnormal findings were a blood-pressure of 13o/11o mm. Hg and a coarse tremor in both hands. His haemoglobin level was 14.9 g. per ~o o m l . and there was a slight leucocytosis of 13,700 per cu. mm. with a normal differential count. Glycosuria 0.25 0.25 0.1 0.1 0.1 TO THEATRE J -1 J. J. J.

Pheochromocytoma crisis after a dexamethasone suppression test for adrenal incidentaloma

“…Including the present case, we identified 14 cases of steroid-induced pheochromocytoma crisis in the English literature between 1969 and 2009 (Table 3) [4][5][6][7][8][9][10][11][12]. There were six men and eight women with the mean age (±SD) of 45.14 ± 13.77 years.…”

“…Several classes of drugs may induce a pheochromocytoma crisis in patients with pheochromocytoma. Presentation of pheochromocytoma after administration of steroid is rarely reported [4][5][6][7][8][9][10][11][12]. In this article, we present a case of a pheochromocytoma crisis induced by a steroid in a patient undergoing a high-dose dexamethasone suppression test (DST) for evaluation of a functioning adrenal incidentaloma and review the literature on steroid-induced pheochromocytoma crisis.…”

Steroid-induced crisis and rhabdomyolysis in a patient with pheochromocytoma: A case report and review

“…In six reports [10][11][12][13][14][15], the pheochromocytoma crisis developed between 12 h and 3 days following steroid administration and therefore, besides synthesis, the release of catecholamine from the pheochromocytoma could be accelerated by the administration of steroid. Critchley et al reported that steroid administration augments the release of catecholamines from isolated perfused dog adrenal glands.…”

“…In 1970, Cowley et al reported a 57-year-old man who developed anxiety, diaphoresis, epigastric pain, and severe hypertension (300/170 mmHg) during an ACTH stimulation test. This was followed by the discovery of a 4-cm pheochromocytoma [11]. In 1977, Daggett and Frank reported a 69-yearold woman with giant cell arteritis who presented with palpitations, tremor, and severe hypertension during her third day of oral prednisone therapy (45 mg daily).…”

“…These include saralasin, sulpiride, droperidol, metoclopramide, ergotamine, caffeine, nimesulide, opiates, histamines, and glucagon among others [5][6][7][8][9]. Our search of the literature found six reports of steroid-induced pheochromocytoma crisis [10][11][12][13][14][15] and only a few reports of rhabdomyolysis in pheochromocytoma patients [16][17][18][19].…”